Frequently Asked Questions

With all burn patients, it is important to initially stop the burning process. Due to size of injury, a dry dressing may be recommended to minimize heat loss.

SHOULD THE BURN INJURY TAKE PRIORITY OVER OTHER TRAUMATIC INJURIES?

Always treat patients according to CPR and Trauma Protocol. Overlook the burn first and ensure no other traumatic or airway injuries are present. Always use airway and c-spine precautions. Once you do get to the burn evaluation stage, stop the burning process first.

WHAT ARE THE GENERAL GUIDELINES FOR FLUID RESUSCITATION, INCLUDING WHAT FLUID, HOW MUCH AND LR VS NS?

In a pre-hospital setting, set fluid to:

Less than 5 years old – 125 cc/hr

6-13 years – 250 cc/hr

Older than 13 years – 500 cc/hr

Once a patient is in the Emergency Department, use the Parkland Formula to calculate fluids:

2-4 cc Ringers Lactate x kg body weight x percent burn

Give the first half over the first 8 hours, and the remainder over the next 16 hours.

2 cc for 14 years or older

3 cc for children younger than 14 years

4 cc for electrical burn injuries

Urine output is an indication of the progression and treatment of hypovolemic shock, or burn shock. Place Foley to accurately measure urine.

Titrate ringers lactate based on urine output:

Adult or young adolescent: 30 to 50 cc/hr

High-voltage electrical injury: 75 to 100 cc/hr

Children under 30kg: 1 cc/kg/hr

If there is no urine output, increase rate of fluids by 1/3. If there is only a scant amount of dark or concentrated urine, pigments, myoglobin, and/or hemoglobin may be blocking the kidney, especially in a high-voltage electrical burn. If urine output and pigment clearing do not respond to increased fluid administration, promptly consult a burn center surgeon.

WHAT ARE THE GENERAL GUIDELINES FOR WHEN TO INTUBATE?

Airway Management

Administer high flow 100% oxygen to all burn patients.

Be prepared to suction and support ventilation if necessary.

Signs of a possible inhalation injury:

Burned in an enclosed area

Dark or reddened oral or nasal mucosa

Burns to the face, lips, nose, including singed eyebrows and nasal hairs

Burns to hands and feet need special attention because of the possible impact on functionality. Timely evaluation by a burn surgeon or specialist is always recommended.

WHY SHOULD WE NOT USE ICE ON BURN PATIENTS?

Ice can cause further tissue damage, even resulting in frostbite. It can also cause burn patients to become cold, which could lower core body temperatures and cause additional complications. Damaged tissue caused by ice can impede the healing process.

HOW DO WE APPLY THE RULE OF NINES?

WHAT SHOULD WE DO IF WE HAVE A TRAUMATIC INJURY TO THE HAND OR OTHER EXTREMITY?

Transport the patient to the closest, most-appropriate facility as soon as possible. While treating, make sure to control the bleeding and keep the extremity elevated and wrapped with lightly moistened gauze. If a digit or larger part is amputated, wrap it in a moist gauze and place in a sterile plastic bag. Place the bag on top of ice for transport.

ARE THERE DIFFERENT PROTOCOLS FOR ELECTRICAL INJURIES?

All electrical injuries should be treated as a trauma. Patients should have cardiac monitoring during transport and in the emergency room. Asystole is the most common cause of death at the scene. Stabilize the wound at the point of initial contact and exit.

Your initial call to (855) 863-9595 will be answered by one of our skilled operators who will connect you directly with one of our burn experts – a burn surgeon or mid-level practitioner – who will begin the process of transferring or scheduling a follow-up appointment for the patient at one of our facilities. Our expert can also answer questions and offer assistance with initial treatment and transfer prep.

WHAT IS THE MAIN DANGER OF A CIRCUMFERENTIAL BURN?

Circumferential injuries require hourly pulse checks to confirm adequate profusion. If swelling occurs and there’s a risk of a compartment injury, an escharotomy or fasciotomy may be performed at the burn center to release the pressure.

WHY IS IT IMPORTANT TO PROPERLY TREAT A PATIENT'S PAIN?

To help with increased consumption of oxygen, morphine sulfate is usually used (if not contra-indicated). For adults, user 3-5 mg IV q 10 minutes or as needed. For children, titrate IV morphine sulfate by weight (O1/mg/kg/dose) or consult a burn center surgeon.

NASOGASTRIC (NG) TUBE PLACEMENT

Place Ng tube and decompress stomach if nausea and vomiting are present, if patient is intubated or TBSA greater than 20%. Keep patient NPO.

Circumferential Burns

Consult a Burn Center surgeon concerning circumferential burns of the extremities or thorax. If not palpable, then use a Doppler ultrasound device. If unable to discern pulses, consult a Burn Center surgeon. If unable to discern pulses, consult a Burn Center surgeon.

Deep circumferential burns of the chest may impair or prevent mechanical ventilation of the burn victim. Escharotomies are rare but occasionally necessary at the referring facility. Consult a Burn Center surgeon.

PREVENTING AND TREATING HYPOTHERMIA

Wrap patient in clean or sterile dry sheet

Place blankets over patient to ensure warmth

Cover head with extra layer

Warm fluids if possible

Hallmarks of child abuse

WHAT MAKES BURNS SUSPICIOUS FOR ABUSE

Unexplained burn

Implausible history

Inconsistent history

Delay in seeking medical care

Frequent injuries, illnesses

Child accuses an adult

One parent accuses the other

Alleged self-inflicted

Alleged sibling-inflicted

Pattern of burn

Immersion burns

Rigid contact burns

Other signs of abuse/neglect

Prior Child Protective Services involvement

If child abuse/neglect is suspected, please contact the local Child Protective Services Office as soon as possible.

Fluid Resuscitation

Calculate Fluids: Parkland Formula

Adults: Ringer lactate: 4ml x weight in kg x %TBSA burn. Give first half of fluids over first 8 hours. Give remaining fluid over next 16 hours. Children over 10 years old: use same formula as above

Children Under 10 Years Old: Use the same formula with addition of maintenance fluid of D5W to maintain glucose levels. Consult Burn Center Surgeon

DETERMINE THE DEPTH OF THE BURN INJURY USING THESE GUIDELINES:

2nd Degree (Partial Thickness)
Reddened, blistered, painful to touch, blanches to touch; when blister derided, weeps fluid from wound. Regularly re-assess second degree burns to ensure the injury had not converted to third degree.

3rd Degree (Full Thickness)
Black, brown, white, or leathery wound, firm in appearance; does not blanch and is not painful to touch

Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if trauma poses the greater immediate risk, the patient should be initially stabilized in a trauma center before being transferred to a burn center. Physician judgement will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols

Burned children in hospitals without qualified personnel or equipment for the care of children

Burn injury in patients who will require special social, emotional or long-term rehabilitation

The premise and promise of the burn center has been to never turn away a patient in need of specialized burn care. Burn and Reconstructive Centers of Colorado is unique in many ways, including treating both children and adults to the comprehensive circle of care offered by our medical professionals.

At Burn and Reconstructive Centers of Colorado, the treatment of patients goes beyond their physical burns and wounds. From the expertise of critical care and pediatric intensivists to the consultation of staff psychiatrists, we truly treat the entire patient. We understand that even a small burn can be catastrophic to entire families, and we work hard to lessen the lasting impact of such injuries.

The acute care is often followed by reconstruction as burn scars can be restricting and interfere with a patients lifestyle. This is often a long process requiring years of reconstructive procedures. Therefore, we have a great opportunity to know our patients and connect with them on a level unlike many other specialties.

Many burn centers focus on the acute injury and once the patient is healed refer them to other surgeons to perform their reconstruction. It has been our experience that having the intimate knowledge of what the patient went through in the initial stages helps us to optimize their reconstructive efforts.

TREATING BURNS AT HOME

Most burns occur at home or work, and the proper response is important both to helping the patient and ensuring proper treatment of the injury.

First, stop the burning process by removing the source of the burn. However, do not endanger yourself. For example, do not try to grab a live electrical wire.

The next step is to remove any jewelry or clothing around the burned area. This will help prevent further damage if swelling occurs. If clothing is stuck to the burn site, do not peel it off. Instead, contact emergency services immediately.

For initial treatment of minor burns, run cool tap water over the burn for at least 20 minutes. For more severe burns, seek medical treatment immediately.

DO NOTDo not apply butter, grease, honey or powder
Do not use cotton balls or wool to clean a burn
Do not apply ice directly to the burn

DOCover the burn with a dry, sterile cloth
Use ibuprofen for pain management

IDENTIFYING SEVERITY OF BURNS

First DegreeRed and painful with no blistering of skin, such as a minor sunburn

Second DegreeRed and painful with blistering – sometimes significantly blistering – of skin. Injuries will maintain a wet appearance.

Third DegreeInjuries have charred appearance, and will be dry to touch. They will have a leathery or white appearance, and be insensate. Treatment of injury will require skin grafting.

Fourth DegreeInjuries will be catastrophic, involve muscle, tendon and bone, and most often require amputation as treatment.

Transfer criteria recommended by the American Burn Association:

Partial thickness burn greater than or equal to 10% TBSA

Any burn involving the face, hands, feet, genitalia or major joint

Any third degree burn

Chemical burn injury

Electrical burn injury

Inhalation injury

Burn injury in patients with pre-existing medical disorders

Burns involving concomitant trauma in which the burn injury poses the greater risk

Burned children in hospitals without qualified personnel or equipment for the care of children

Burn injury in patients who will require special social, emotional, or long-term rehab

Breast plastic surgeries are minimally invasive procedures that restore and improve the size, shape and position of the breasts. Options for these surgeries include reconstruction, augmentation (enlargement), reduction and lift. Breast plastic surgeries are tremendously beneficial to women who have lost their breast(s) from mastectomy or lumpectomy and would like to have breast reconstruction to restore natural-looking shape, appearance and size, or lost breast volume due to pregnancy or nursing. Patients may also want breasts that are in proportion with their body size, or desire a fuller profile. At BRCC, our highly-trained and experienced plastic surgery team will discuss your priorities to help you choose the right procedure and achieve your goals.

Is It Cosmetic Surgery?

In most cases, breast restoration is treatment of a disease and considered a reconstructive surgery, not a cosmetic procedure.

When’s the Best Time to Have Breast Reconstruction?

Our team will work with you to identify the appropriate time for your procedure, accounting for your medical condition, procedural approaches, anatomy and personal desire. Our goal is to create a personalized plan with you to achieve your goals with optimal outcomes in a safe manner. Patients who have begun chemotherapy or radiation will need to wait until they have completed that treatment.

Breast Reconstruction Approaches

Implants – Implants are made out of silicone, saline or a combination of both. They are placed beneath the chest muscle. This differs from breast augmentation where implants are placed on top of the chest muscle.

Flaps – During this reconstructive procedure, a breast is created with tissue taken from other parts of the body, such as the thighs, abdominal or gluteal regions. The tissue is then transplanted to the chest, where surgeons can reconnect blood vessels.

Planning for Breast Reconstruction

Women who will have a mastectomy, or may lose a breast from a lumpectomy, have options for surgery:

Immediate Breast Reconstruction – Women who are not undergoing chemotherapy or radiation treatment may choose to have reconstruction done in conjunction with their mastectomy or other surgical intervention.

Delayed Breast Reconstruction – We recommend that women undergoing chemotherapy or radiation treatment delay their breast reconstruction. If breast reconstruction is not delayed, a reconstructed breast may lose its appearance, change in shape or texture, become painful and could potentially put a person at-risk. A tissue expander will be inserted after the mastectomy to keep the breast skin that was saved during the procedure in preparation for the final reconstruction, which will be scheduled several months after radiation treatment is complete.

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Frostbite

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The specialty of burn care is not relegated to chemical, electrical, flame and scald injuries. At BRCC, our team of highly-trained and experienced surgeons and plastic/reconstruction specialists are also trained in the most advanced treatment and management of cold injuries including thrombolytic therapy.

Cold injuries can result in temporary or permanent tissue damage caused by prolonged exposure to temperatures less than 23°F. Injuries can range from frostnip to more complex injuries including significant local tissue loss and/or limb amputations. The classification of frostbite injuries is similar to burn injuries:

First Degree: Superficial without blister formation; Frostnip

Second Degree: Light colored blisters with subsequent peeling

Third Degree: Dark blisters that evolve into thick, black eschar

Fourth Degree: Involves bone, tendon and/or muscle

A better understanding of the pathophysiology of the disease process has led to recent advancements in the treatment of frostbite. No longer considered to be a condition of simple tissue freezing, cold injuries are now recognized to be a more complex ailment associated with local tissue injury and vascular occlusion. Today, treatments are designed to rewarm the affected tissues rapidly, while improving blood flow to the injured area with thrombolytics. Tissue plasminogen activator, commonly known as tPA and given to stroke victims, is a proven, effective treatment for frostbite injuries resulting in significantly lower amputation rates. Patients presenting with frostbite should be viewed as a vascular emergency and immediately be referred to a burn specialist who is trained in the use of tPA. Rapid diagnosis and treatment of cold injuries can significantly reduce the morbidity associated with this injury.

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Hand & Extremity Injuries

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The specialties of the Burn and Reconstructive Centers of Colorado Hand Team include:

Burns and wounds are not the only injuries healed at Burn and Reconstructive Centers of Colorado. Our team of plastic and reconstruction specialists offers cosmetic, emergency and elective surgeries, including breast enhancement or reconstruction, hand and extremity operations as well as other procedures.

Hand and upper extremity injuries account for one-third of all emergency room injuries and are the most common disabling work injuries. Meanwhile, burning and crushing injuries to the hand are one of the likeliest injuries for children under the age of six.

In recent years, Burn and Reconstructive Centers of Colorado has assembled a team of hand specialists who can treat cases ranging from traumatic de-gloving injuries to simple sprains. They are available 24 hours a day, seven days a week for emergency cases or consultations. With 29 major and minor bones, 29 joints, 123 ligaments, 48 nerves and 35 muscles, the hand and lower arm are complex areas that requires a skilled assessment and treatment plan.

If you are experiencing pain in your upper-extremities, including wrist, hand, and fingers, contact our office to schedule an appointment today. They can offer a wealth of treatments beyond surgery, including medication, topical treatment, injections, or monitored therapy.

Laser scar revisions can assist with loosening of scars to improve range of motion, decrease itching and pain from scars and offer an improved appearance of the scarred area.

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Outpatient Clinic

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We provide coordinated care with a team of skilled and experienced professionals that includes surgeons, certified wound specialists, nurses, physical & occupational therapists, nutrition counselors and social services coordinators.

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Reconstructive Surgery

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One of the most important steps in the healing of a catastrophically burned patient is the process of reconstruction, especially of extensively burned areas. Due to scar formation from deep second or third degree burns, patients will likely need reconstruction to improve restrictive and hypertrophic burn scars. These burn scars to the face, neck, hands and other regions of the body can restrict motion, such as chewing, drinking and hand or neck or leg movements.

Our team of highly-trained and experienced plastic and reconstructive surgeons at Burn and Reconstructive Centers of Colorado, Inc., is continuing to develop different avenues to best treat our patients, those with congenital and acquired skin anomalies, wounds and people interested in generally improving their appearance and/or self-esteem. Through our experience of working with thousands of patients, we have developed the skills necessary to create a thorough treatment plan to improve the aesthetics, form and function of our burn patients. We are not only involved in the reconstruction process, but also in the in the acute phase of patient care. This helps plan procedures for future reconstruction, enhance rehabilitation and overall improve patients’ form, function, aesthetic outcome and, ultimately, their quality of life.

Burn and reconstructive surgery is not the only service provided by our surgeons at BRCC. Our team of highly-trained and experienced surgeons and plastic/reconstruction specialists are trained in the treatment and management of skin and soft tissue disorders, including:

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are degenerative skin disorders differentiated by percentage of involved body surface area. While there is some overlap in categorization of SJS and TEN, TEN is characterized with involvement greater than 30% of total body surface area. Patients often present with a patchy reddening or detachment of the top layer of skin following exposure to a “trigger,” most commonly a medication. The disease process affects all epithelial tissues of the body and is associated with a significant inflammatory response. The combination of epithelial loss and severe inflammation leaves the patient susceptible to infections and multi-organ system failure. The care and treatment for these individuals is similar to those with a thermal injury. It is for this reason why the medical community favors treatment of these individuals at a multi-disciplinary burn center to limit morbidity and mortality.

Necrotizing fasciitis (NF) is a bacterial infection of the skin, commonly occurring when bacteria pass into the body through an open cut, scrape, burn wound or other puncture wound. Patients with NF may complain of swelling and muscle soreness at the site of the infectious process. The skin is generally warm to the touch and red or purple in color. As the disease progresses, it may be accompanied by blisters, ulcers or blackening of the skin. NF is a medical emergency and should be treated in an urgent manner as the bacteria quickly spreads through connective tissue, and can lead to amputations or death within a narrow window of time. Aggressive surgical debridement, coupled with systemic antimicrobials and hyperbaric oxygen, is often required to prevent the infection from continuing to spread and potentially result in significant morbidity and mortality.

Diabetic ulcers occur in approximately 15% of diabetic patients. If treated properly, patients can avoid amputation, which affects about 1 in 5 patients who develop an ulcer. Patients who develop ulcers should seek immediate attention from a specialist.

Cellulitis is a bacterial skin infection that can spread rapidly if not treated immediately. Cellulitis can result in necrotizing fasciitis or sepsis, potentially life threatening conditions. Patients often present with painful, swollen areas of red skin that are warm to the touch. Although it’s most commonly seen on the skin of the lower legs, it can occur anywhere throughout the body. Untreated or mistreated cellulitis can extend through the soft tissues into the lymph nodes and bloodstream, resulting in life threating conditions. Cellulitis should be treated aggressively with antimicrobials while excluding the diagnosis of necrotizing fasciitis and sepsis. Significant cellulitis can result in morbidity and mortality and thus should be treated by infectious experts at a medical facility or burn center.

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Events

Established in 2007, the Joseph M. Still Burn Symposium is an annual gathering of medical professionals dedicated to the constant improvement of burn care in America. With sessions presented by leading experts and the availability of educational credits, the Symposium provides your company with a specific, targeted audience.

Foundation

BRCA FOUNDATION

The BRCA Foundation is a 501(c)(3) organization dedicated to improving patient care, supporting patients and families after they have been discharged from one of our centers, and facilitating education about burn, wound and hand care throughout various medical communities.

Mission StatementThe healing and helping of patients goes far beyond the walls of our burn centers. The BRCA Foundation is committed to helping patients and their families, while continuously working to improve care throughout the world.

Our foundation was founded on three guiding principles:

Patient Support

Education & Scholarship

Community Outreach

To learn more about us or find out how you can help support our mission, please email: [email protected]

All donations to Burn Foundation of America Foundation are tax deductible.